Public Health Commons^™

Pre-Operative Clinical Variation By Health Insurance Carrier In 12,285 Male Surgical Patients With Moderate Morbid Obesity, Matthew E. Moore, Gus J. Slotman

Rowan-Virtua Research Day

In the ongoing obesity epidemic, every surgeon now treats patients with weight-related medical problems. In managing these medically fragile surgical patients, every clinical insight helps. While variation according to health insurance has been reported in mixed sex bariatric surgery populations, whether or not clinical characteristics in the subset of moderately obese male surgical patients vary by insurance carrier is unknown. The objective of this study was to identify clinical variation by insurance type in moderately obese men.

Results showed that pre-operative clinical characteristics of moderately obese male surgical patients vary by the health insurance coverage type to which they subscribe. …

Ethnic And Demographic Differences In Colectomy Rates And Timing For Ulcerative Colitis: 2007-2014, Daniel Bodek, Alana Persaud, Brian Blair, Ahlawat Sushil

Rowan-Virtua Research Day

Ulcerative Colitis (UC) is a chronic inflammatory disease of the bowel, with one third of patients requiring a colectomy for fulminant disease and tissue dysplasia. In 2007, infliximab was approved for induction and maintenance of remission in UC, with some evidence to suggest a potential reduction in colectomies. The aim of this study is to examine relative colectomy rates for UC among different ethnicities from 2007 to 2014 in order to evaluate for development of new trends or disparities.

Discrepancies in colectomy rates and timing are seen in our models which mirror closely findings in a prior study from 1999-2003 …

Pre-Operative Risk Of Medical Complications Varies By Health Insurance Carrier In Moderately Obese Women: Medicaid V Medicare V Private V Self-Pay, Paul Osterdahl, Melissa Gott, Amanda Sundling, Gus J. Slotman

Rowan-Virtua Research Day

Introduction: Clinical variation by health insurance status in mixed sex bariatric surgery populations is reported, but such variation among moderately obese women is unknown.

Objective: to identify pre-operative variation by health insurance in female surgical patients.

Conclusions: Pre-operative characteristics of moderately obese women vary by insurance. Medicare’s highest risk for cardiopulmonary problems and diabetes, and Medicaid’s highest asthma, abdominal-hepatobiliary, and psychological/behavioral complications should be considered in managing moderately obese women subscribing to these carriers.

Panniculectomy Performed In Conjunction With Gynecologic Surgery In The Morbidly Obese Patient - A Nsqip Analysis And Meta-Analysis Of The Literature, Shayoni Nag, Tirth Patel, Steven C. Bonawitz

Rowan-Virtua Research Day

Purpose: Panniculectomy is a common procedure in plastic surgery, often performed following massive weight loss and in morbidly obese patients. It can be performed in combination with various gynecologic procedures based on the rational that it will reduce complication rates.^{1, 2, 3} These studies fail to provide proof of these claims for reasons including study design and the lack of inclusion of both morbidly obese and non-morbidly obese patients. Recent medical practice has focused increasingly on minimizing patient morbidity and trends in reimbursement are moving towards penalizing practices which increase complications.

Methods/Results:We reviewed the NSQIP database to assess …

An Analysis Of Providers’ Perceived Barriers To Contraceptive Access And Reproductive Healthcare, Ashley Weadick

Senior Honors Projects

The field of Reproductive Healthcare covers nearly every aspect of women’s health. Even during non-reproductive years, Reproductive Healthcare is important for women because it provides medical care often essential to their lives before and after child-bearing years. Contraception is needed by many women before they wish to have children, and after they have any children they choose to have, they may again wish to use contraception or they may require help with postpartum care. One of many reasons why Reproductive Healthcare is so important is because it explains the wide array of options available when it comes to methods of …

Transition In Occupations Of Refugees During Resettlement, Jacqueline-Elizabeth Cantrell, Kimberley K. Banuelos, Adam Chan, Jennifer H. Daine

Occupational Therapy | MSOT Capstone Projects

Purpose: In 2016, there were 22.5 million refugees worldwide (UNHCR, 2017). California resettled just over 5,000 of those 85,000 (Igielnik & Krogstad, 2017). Limited research has been conducted in the United States (U.S.) focusing on the refugee experience; furthermore, there is a significant gap in research regarding the impact of the refugee experience on the occupations of refugees as they transition to living in the U.S. Smith (2012) explored the adaptation of cultural weaving among Karen refugees to maintain their previous occupations and the impact of daily weaving on their lives within Western culture; however, the study focused only …

The Health Care Costs Of Financial Exploitation In Maine, Kimberly I. Snow Mhsa, Yvonne Jonk Phd, Deborah Thayer Mba, Catherine Mcguire Bs, Stuart Bratesman Mpp, Charles A. Smith Phd, Erika C. Ziller Phd

Disability & Aging

This study sought to determine the Medicare and Medicaid costs experienced by dual eligible older adults in Maine for whom Maine Adult Protective Services (APS) substantiated allegations of elder financial exploitation and to compare them to those of Maine’s general older population. The analysis is an important step forward in estimating the medical costs associated with elder abuse.

Elder financial exploitation may result in significant public burden on Medicare and Medicaid, shouldered by taxpayers. Efforts to detect, investigate, prosecute, and mitigate this abuse will benefit not only the victims, but also the financial stewardship of these public programs.

Increasing Low-Income Residents’ Access To Fresh Produce Through A Local Mobile Pantry, Laura Wasson

Human Nutrition and Hospitality Management Undergraduate Honors Theses

Seeds that Feed (STF) is a mobile food pantry located in Fayetteville, Arkansas. STF receives produce from local farmers to distribute to residents in low-income housing sites throughout Northwest Arkansas. According to Feeding America, food insecurity affected 14.3% Washington County, Arkansas’ population in 2016. The purpose of this study was to determine if STF’s model is an effective way to increase individuals’ access to fresh fruits and vegetables and increase their potential to meet the United States Department of Agriculture’s Food Patterns (USDA-FP) for to fruit and vegetable consumption. Twenty-three participants from three sites completed the study. A survey was …

Factors Influencing Unmet Medical Need Among U.S. Adults: Disparities In Access To Health Services, Ahmad Khanijahani

Electronic Theses and Dissertations

Inequities in access to health services has negative consequences on individual well-being, and imposes financial and emotional burden on patients, families, health care systems, and the public. Inequities engendered from differences in socioeconomic status, health insurance coverage, race, and other characteristics can engender disparities. This study aimed to identify the potential predictors of unmet medical need among the civilian noninstitutionalized U.S. adults. Inability to receive needed medical care or receiving medical care after a delay, due to the associated costs, constructed unmet medical need. This study used a four-year (2014-2017) National Health Interview Survey (NHIS) data (sample size: 296,301 adults) …

Innovation And Equity In Public Health Research : Testing Arts-Based Methods For Trauma-Informed, Culturally-Responsive Inquiry., Tasha Golden

Electronic Theses and Dissertations

As the field of Public Health has shifted from a biomedical paradigm to a social ecological approach, focusing on health equity and social determinants of health, it has increasingly acknowledged the roles of culture and trauma in health outcomes. The field has responded by modifying some research practices, but continues to prioritize conventional methodologies—with few options designed to foreground trauma- and cultural-responsiveness. Unfortunately, to the extent that conventional approaches require health to be defined, communicated, or valued according to dominant norms, they risk perpetuating inequities. Health equity therefore requires the development of research methodologies that increase inclusivity and access, elicit …

A Framework For Learning During An Honors Internship: Embold Health Inc., Haley Haldeman

The Eleanor Mann School of Nursing Undergraduate Honors Theses

Embold Health Inc. is a health care analytics start-up company that identifies top performing providers using large data sets and clinically nuanced measurement. A comprehensive assessment of quality, appropriateness, and cost is what Embold Health delivers. Embold allows payers more control in choosing providers within their region. Being able to identify top provider behaviors through rigorous data driven measurement is significant both clinically and commercially; it provides the opportunity to increase value of care, decrease waste, and drive down cost.

Over the past year as an intern, I’ve had a first-hand look into the complexity that surrounds data driven health …

Higher Education For At-Risk Youth In Santa Cruz County, Abbye Bohon

Capstone Projects and Master's Theses

Friday Night Live, County of Santa Cruz is an adult-youth led partnership that advocates for the communities’ aids and needs. At-risk youth undergo higher chances of violence, disruption, demeanor, and staying in trouble due to the minimal amount of exposure when it comes to general education. Too many at-risk youths do not pursue higher education in the county of Santa Cruz due to the lack of exposure of higher education in this particular community. The purpose of this project is to raise awareness of what higher education looks like to this population through an 8-weekly session implementation and evaluation process …

Adverse Childhood Experiences, Homeless Chronicity, And Age At Onset Of Homelessness, Joseph T. Tucciarone Jr.

Electronic Theses and Dissertations

Childhood adversity is associated with numerous negative outcomes across multiple domains, including mental and physical health, interrelationships, and social functioning. Notably, research suggests that childhood adversity has a dose-response relationship with these outcomes; that is, greater numbers of adverse experiences in childhood are associated with worse outcomes. These outcomes overlap with many risk factors of homelessness. This study sought to address two questions: 1) Does a dose-response relationship exist between childhood adversity and chronic homelessness? 2) Does childhood adversity negatively predict the age at which homelessness first occurs? Adults experiencing homeless who are accessing homeless services in the Tri-Cities area …

Exploring The Relationship Of Digital Information Sources And Medication Adherence, Cody Arbuckle, Daniel Tomaszewski, Lawrence Brown, Jon C. Schommer, Donald Morisky, Chelsea Parlett-Pelleriti, Erik J. Linstead

Pharmacy Faculty Articles and Research

We present a retrospective analysis of data collected in the United States from the 2015 National Consumer Survey on the Medication Experience and Pharmacists’ Role in order to model the relationship between health information sources and medication adherence and perception. Our results indicate that while the digital age has presented prescription users with many non-traditional alternatives for health information, the use of digital content has a significant negative correlation with pharmaceutical adherence and attitudes toward medication. These findings along with previous research suggest that in order to fully realize the potential benefits of the digital age in regards to patient …

Deploying Care Managers From Care Management Agencies Into Primary Care: A Pilot Study, Lauren Klein Levine

NYMC Student Theses and Dissertations

Background: As the nation shifts to value based payment programs (VBP), financial incentives drive primary care providers (PCPs) to improve outcomes and reduce costs. One method to drive physicians to focus their practices and to increase time working at the top of their licenses is the use of care management (CM) services to meet these goals but the resources needed to implement CM are a barrier. In the Hudson Valley, PCPs embedded local CM staff to provide CM services. This study assesses the provider and care manager perceived patient outcomes from CM, barriers to successful implementation, resources required, total cost …

Variation And Change Over Time In Promis-29 Survey Results Among Primary Care Patients With Type 2 Diabetes, Juell Homco, Kristin Rodriguez, David R. Bardach, Elizabeth A. Hahn, Suzanne Morton, Daren Anderson, David Kendrick, Sarah Hudson Scholle

Journal of Patient-Centered Research and Reviews

Purpose: We sought to describe results of patient-reported outcome measures implemented among primary care patients with diabetes and explore factors associated with changes in scores over time.

Methods: Two organizations serving diverse patient populations collected the PROMIS-29 survey at baseline and 3-month follow-up for patients with type 2 diabetes. Bayesian regression analysis was used to examine the relationship between patient characteristics and changes in PROMIS-29 scores. Exploratory analyses assessed relationships between goal-setting and changes in scores.

Results: The study population reported substantially more problems with physical functioning (mean: 42.5 at Site 1 and 38.9 at Site 2) and pain interference …

Team-Based Care And Patient Satisfaction In The Hospital Setting: A Systematic Review, Kristen K. Will, Melissa L. Johnson, Gerri Lamb

Journal of Patient-Centered Research and Reviews

Purpose: Limited research examining the relationship between team-based models of care and patient satisfaction in the hospital setting is available. The purpose of this literature review was to explore this relationship as well as the relationships between team composition, team-based interventions, patient satisfaction, and other outcomes of care when measured as part of the study.

Methods: A systematic appraisal of research studies published through February 2017 was conducted using PubMed, Cochrane Library, CINAHL, Embase, Ovid, gray literature and Google Scholar. Inclusion criteria were 1) experimental (randomized control trials), quasi-experimental, or non-experimental (cross-sectional) study design; 2) team-based care interventions; 3) hospital …

Vulnerability And Physical Well-Being Of Caregivers: What Relationship?, Salvatore Settineri, Fabio Frisone, Angela Alibrandi, Emanuele Maria Merlo

Journal of Mind and Medical Sciences

Objectives. To assess relationships among burden, compassion, and well-being and health among an active group of caregivers.

Methods. 301 caregivers with female prevalence (F = 61.1%, M = 38.9%) and ages between 18 and 84 years old (average = 38.72; SD 13.36) participated. Evaluation was carried using standardized instruments to assess: Burdens (CBI), dimensions related to Compassion and Burnout (ProQOL-5), State of Well-being (Who-5) and particular health-related domains (Emotional state, Physical health, Depressive Polarity, Dysphoric Polarity-SF-36). Correlational analyses and multivariate linear regressions were performed.

Results. Positive correlations emerged between Burdens and Compassion Fatigue, Well-being and Satisfaction; inverse correlations emerged among …

Preventive Health Service Use Among Rural Women, Erika C. Ziller Phd, Jennifer D. Lenardson Mhs, Nathan Paluso Mph, Jaclyn Janis Bsn, Rn

Access / Insurance

Preventive health services and screenings are an important component in the continuum of care provided to individuals across all ages. Yet, research has shown that rural residents generally use fewer preventive health services and screenings. This study used the National Health Interview Survey to examine receipt of preventive health services (cholesterol check, fasting blood sugar test, mammogram, pap smear, and receipt of the HPV vaccine) by rural and urban women over the age of 18. Findings indicate that rural women were less likely than their urban peers to receive preventive health services, and that some of the differences may be …

Nhs England Always Events® Program: Developing A National Model For Co-Production, Claire Marshall, Angela Zambeaux, Esther Ainley, David Mcnally, Jenny King Miss, Lorraine Wolfenden, Helen Lee

Patient Experience Journal

NHS England, the Institute for Healthcare Improvement, Picker and NHS Improvement started the work described in this article to strengthen how patients, carers and staff working together in co-design and co-production can make a real difference in improving experience of care. Always Events®, which is an improvement methodology for the co-design and consistent implementation of those aspects of patient experience that matter most to patients in a health care setting, was chosen. The approach has been to first test the methodology with three organizations then to spread to a substantial proportion of acute health care providers, with concurrent scale-up within …

Interprofessional Collaboration To Improve And Sustain Patient Experience Outcomes In An Ambulatory Setting, Natalie Sanchez, Kimberly Hermis

Patient Experience Journal

Patient experience is an important factor across diverse healthcare delivery settings. Despite enhanced attention to and advances in patient experience, many of the published initiatives focus on in-hospital care and opportunities have been identified to continue to strategically address patient experience in the ambulatory setting. This quality improvement initiative presents the development of an interprofessional approach to patient experience in a freestanding ambulatory oncology center. The objective of this initiative was to improve and sustain patient experience, as reflected in the Consumer Assessment of Healthcare Providers and Systems (CAHPS) scores via Press Ganey. This approach consisted of redesigning a previously …

Twelve Principles To Support Caregiver Engagement In Health Care Systems And Health Research, Kerry Kuluski, Kristina M. Kokorelias, Allie Peckham, Jodeme Goldhar, John Petrie, Carole Anne Alloway

Patient Experience Journal

Family and friend caregivers (i.e., unpaid carers) play a critical role in meeting the needs of people across various ages and illness circumstances. Caregiver experiences and expertise, which are currently overlooked, should be considered in practice (such as designing and evaluating services) and when designing and conducting research. In order to improve the quality of health care we need to understand how best to meaningfully engage caregivers in research, policy and program development to fill this important gap. Our study aimed to determine principles to support caregiver engagement in practice and research. A pan Canadian meeting brought together 48 stakeholders …

Does The Use Of Volunteers And Playbooks In Pediatric Primary Care Clinic Waiting Rooms Influence Patient Experience?, Tara Servati, Kalpana Pethe, Victoria Tiase

Patient Experience Journal

The purpose of this secondary data analysis was (1) to understand the use of a playbook as a positive distraction technique and (2) to explore the use of volunteers in the waiting room of an outpatient pediatric clinic setting. Specifically, the study examined the impact on perceived wait time, overall quality of care, and patient experience in a convenience sample of patients. Data obtained for a pilot program for improving patient experience were aggregated for exploratory analysis. Although significant differences in perceived wait time or patient experience were not found, the cohort exposed to both the playbook and volunteer intervention …

A Case Study Of The Patient Wait Experience In An Emergency Department With Therapy Dogs, Colleen A. Dell, James Stempien, Lindsey Broberg, Alicia Husband, Lacey Jurke, Betty Rohr, Jane Smith, Joseph Rubin, Susan Tupper, Donna Goodridge, Cathie Fornssler, Logan Fele-Slaferek

Patient Experience Journal

The quality of patient healthcare is a growing concern in Canada’s hospital emergency departments (ED) due to increasing wait times and associated adverse outcomes. A developing body of literature indicates that therapy dogs can positively impact the patient experience. In 2016, members of our team partnered with the Royal University Hospital (RUH) in Saskatchewan to become the first ED in Canada to integrate a visiting therapy dog to positively impact the patient wait experience. The aim of this preliminary case study was to examine if and how this unique initiative impacted patients’ feelings during their ED wait. A brief questionnaire …

The Impact Of Response Rate On Hospital Consumer Assessment Of Healthcare Providers And System (Hcahps) Dimension Scores, Erin Godden, Andrea Paseka, Jan Gnida, Joe Inguanzo

Patient Experience Journal

Patient experience measurement is receiving considerable attention from hospital executives, healthcare leaders, purchasers such as the Centers for Medicare and Medicaid Services (CMS), and patients. It is therefore appropriate and necessary to examine the methods of survey administration, and the analysis presented here seeks to understand the impact of one particular aspect of the measurement: response rate. Utilizing publicly reported HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) data from Hospital Compare, a positive correlation between response rate and HCAHPS scores nationwide was identified and replicated. This correlation, which was most recently published by the Hospital Quality Institute (HQI) …

Comparing Psychiatric Care Experiences Shared Online With Validated Questionnaires; Do They Include The Same Content?, Rebecca Baines, John Donovan, Samantha Regan De Bere, Julian Archer, Ray Jones

Patient Experience Journal

Patient feedback is considered integral to patient safety and quality of care. However, limited research has compared the content of validated questionnaires with subjective patient experiences shared online. The aim of this study was to therefore identify and compare the content of psychiatric care experiences shared online with validated questionnaires. All research was conducted in co-production with a volunteer mental-health-patient-research-partner. We analysed all reviews published on the United Kingdom’s leading health and social care feedback platform Care Opinion, between 2005-2017 that discussed adult psychiatric care and compared findings with two validated questionnaires (ACP360 and General Medical Council patient feedback questionnaire). …

“Can I Still Get A Tattoo?” Patients’ Experiences Across The Clinical Trajectory For Metastatic Melanoma: A Dynamic Narrative Model Of Patient Journey, Klay Lamprell, Melvin Chin, Jeffrey Braithwaite

Patient Experience Journal

Advanced and metastatic cancer has a complex diagnostic and management profile that places a heavy long-term burden on patients and healthcare systems. Little attention has been given to patients’ experiences across their entire clinical journey. Using a qualitative, longitudinal methodology over a ten-month period, we examined the symptom-to-outcome trajectories of seven people attending a medical oncology clinic at a large, public tertiary referral center in Sydney, Australia. Rather than care being experienced as a largely linear progression through diagnosis, treatment and onto surveillance in which life may return to ‘normal’, participants are embedded in a cyclical clinical pathway. Recurrence or …

Patient Perception Of Telephone Follow-Up After Resection For Colorectal Cancer: Is It Time For An Alternative To The Out-Patient Clinic?, Marcus Gilmartin, Nicholas Leaver, George Hall, Helena Fawdry, Seung Lee, James Nicholson, Ramya Kalaiselvan, Raj Rajaganeshan

Patient Experience Journal

The economic reality of modern healthcare provides a timely reminder to clinicians of their duty to provide outstanding and cost-effective care. Although multiple guidelines outline investigation, management and surveillance of colorectal cancer, none advocate a particular delivery method. Nurse-led telephone follow-up in multiple specialties has demonstrated equivalent clinical outcomes and patient satisfaction when compared to traditional outpatient department follow-up. This paper aims to compare nurse-led telephone and outpatient follow-up, following surgical resection of colorectal cancer (CRC), focusing on patient perceptions. This cross-sectional study distributed adapted patient satisfaction questionnaire (PS-Q 18) to patients undergoing surveillance following CRC resection via either nurse-led …

How Have Patients' Experiences Of Cancer Care Been Linked To Survival? A Systematic Review, Saleh A. Alessy, Margreet Lüchtenborg Dr, Elizabeth A. Davies Dr.

Patient Experience Journal

Patient experience of care remains an important indicator of health care quality. Although studies show care experiences are associated with health outcomes for some conditions, the situation for cancer is unclear. New datasets on cancer patients in the US, Canada, and UK linking information on experiences and survival may enable an exploration of any association. This review aimed to identify studies linking any aspect of cancer patients’ experiences to their survival, to inform future analyses. We performed a systematic review using Medline database from January 1998 until March 2018.

The settings included outpatient oncology clinics, primary care, hospitals, and cancer …

Representing The Patient Experience Of Heart Failure Through Empathy, Journey And Stakeholder Mapping, Leanna Woods, Jed Duff, Erin Roehrer, Kim Walker, Elizabeth Cummings

Patient Experience Journal

Heart failure is a long-term condition requiring those affected to manage numerous self-care related activities. People with heart failure report multiple challenges accommodating self-care activities in their every-day life. The aim of this study is to (1) understand the experience of people with heart failure and their caregivers in the local patient population, and (2) visually represent these experiences to inform the design of a mobile health intervention supporting self-care. Seven patients and four family caregivers were interviewed using an empathic approach. Data was collected using rapid design methods including an empathy map to uncover patient and caregiver perspectives and …